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8/3/2019 Halitosis or Oral Malodor
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Halitosis or oral malodor
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Definition
Offensive odor originating from the
oral cavity or air-filled cavities such
as the nose, sinuses, and pharynx.
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Epidemiology
Breath malodor considered as social
problem.
Poorly documented in most countries.
Japanese study reported that VSCs
increase with age , tongue coating &
periodontal inflammation.
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Volatile Sulfur Compounds
Protein metabolismby the bacteria; production of
sulfur-containing gases known as volatile sulfur
compounds (VSCs).
Exhaling these gases causes "bad breath"
The primary VSCs produced in the oral cavity aremethyl mercaptan (CH3SH) and hydrogen sulfide
(H2S) and dimethyl sulfide[(CH3)2S].
Other compounds in mouth air may also beoffensive such as indole , skatole andbutyric or
propionic acid.
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Intra oral causes
Dentition.
Periodontal infections.
Tongue and tongue coating.
Dry mouth (Xerostomia).
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Dentition
Deep carious lesions.
Extraction wounds filled with a
blood clot.
Crowding of teeth.
Acrylic dentures.
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Periodontal infections
In deep pockets, there is increased production
of VSCs
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Tongue and tonguecoating
The dorsal tongue shows a very irregular
surface topography.
Contain high number of papillae (filiform0.5mm in length , fungiform 0.5 to 0.8mm ,
vallate 1mm in length).
A fissured tongue and a hairy tongue have and
even rougher surface.
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Xerostomia
Causes:Medications:
antihistamines, antidepressants, antipsychotics,
benzodiazepines, anti-Parkinson agents, diuretics, systemic
bronchodilators, beta-blockers, and anticholinergic.
alcohol-containing mouth-rinses,
cancer,
high fever,
severe dehydration
mouth breathing
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Xerostomia; leads to Halitosis:
less mechanical washing.
pH raise above 7.0.
Reduced salivary antibacterial components.
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Extra Oral Causes
Postnasal drip.
Tonsils.
Gastrointestinal Tract.
Diabetes.
Liver Diseases.
Upper Respiratory Tract.
Trimethylaminuria: It is a genetic disorder in which the
body is unable to break down trimethylamine, a
compound derived from the diet. it is characterized by
an offensive body odor that smells like rotting fish.
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Postnasal drip
Accumulation of mucus in the postnasal space caused by:hypersecretion from the paranasal sinuses or adisturbance of normal drainage
The result of;
allergic rhinitis, acute or chronic sinusitis
anatomic obstructions;
nasal polyps,
enlarged adenoids in children, septal deflections,
congenital abnormalities,
foreign bodies
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Tonsils
Causes transient odors especially with the
production of small, soft, whitish-
yellowish secretions called tonsilloliths. Tonsilloliths migrate from the tonsil area
into the oral cavity onto the dorsum of
tongue. A foul odor is emanated as theybreak up.
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Gastrointestinal Tract
Rarely Responsible for bad breath.
The following pathologies might be responsiblefor less than 1% of malodor :-
Zenkers diverticulum.
Gastric hernia.
Regurgitation esophagitis
*ZD. is a pouch that forms at the back of thethroat at the junction of the pharynx and the
esophagus
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Diabetes & Liver Diseases
Diabetic ketoacidosis and hyperglycemia
produce a sweet, fruity breath malodor.
Liver failure is associated with acharacteristic sweet amine odor that is related
to the amount of expired dimethyl sulfide
produced by bacterial action on sulfur-containing amino acids.
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Upper Respiratory Tract
Halitosis may be a manifestation of
infection, inflammation, or malignancy of
any part of the upper respiratory tractincluding bronchitis, pneumonia,
bronchiectasis, and tuberculosis.
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Trimethylaminuria
Hereditary metabolic disorder.
Typical fishy odor of breath, urine, sweat,
expired air, and other body secretions.
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Psychosomatic halitosis
Imaginary halitosis.
Needs reassurance; psychological
management.
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Examination for Halitosis
Organoleptic measurement.
Portable Gas chromatography.
Portable Sulfide monitor.
Electronic Nose.
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Organoleptic measurement
Sensory test; scored on the basis of the examinersperception of a subjects malodor.
Sniffing the patients breath and scoring the level of oral
malodor. 0= no odor.
1=barely noticeable odor.
2=slight but clearly noticeable odor.
3=moderate odor. 4=strong offensive odor.
5=extremely foul odor.
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Organoleptic measurement
Patients must abstain from:
Antibiotics; 3 weeks before test
Eating garlic, onion and spicy foods; 48hrs
Scented cosmetics; 24hrs Ingesting any food, oral hygiene practices, oral rinse,
smoking; 12hrs
Examinerrefrain from:
Drinking coffee, tea or juice
Smoking
Using scented cosmetics before assessment
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PortableGas chromatography
Small amount of breathsample.
Aspirated with a plasticsyringe.
Injected into the inputport of the GC.
The Computer displaysthe detection and
amount of the threeimportant VSCs (inppb) within 8min.
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One part per billion is like
one sheet in a role of toiletpaper stretching from New
York to London.
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Portable Sulfide monitor
Electronic deviceanalysis theconcentration ofH2S&CH3SH.
Should be done after atleast 4hrs of fasting andafter keeping the mouthclosed for 3min.
Absence of breathmalodor leads toreadings of 100ppb orlower.
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Electronic Nose
An artificial Nose that has the same
capacities as the human Nose.
Currently significant improvement
still need to be made.
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Treatments ofHalitosis
Treat the underling cause.
Mechanical Reduction of intraoral
nutrients and micro organisms. Chemical Reduction of oral microbial
load.
Masking the malodor.
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